浅探叶桂与张机论治胸痹心痛之异同  

Discussion on the similarities and differences between YE Gui and ZHANG Ji in the treatment of thoracic obstruction heartache

作　　者：王婷婷 杨新新 李翠云 刘畅 刘丽清[1] WANG Tingting

机构地区：[1]菏泽医学专科学校,山东菏泽274000

出　　处：《中医临床研究》2024年第23期89-92,共4页Clinical Journal Of Chinese Medicine

摘　　要：在《金匮要略》中,医圣张机(字仲景)较系统地论述了胸痹心痛。叶桂(字天士)在继承张机理论的基础上结合自身临床经验,对胸痹心痛论治有独特见解。叶桂与张机均认为“阳微阴弦”为胸痹心痛的病机。胸中阳气虚衰,不能温养脏腑,脏腑功能失常,致气滞、血瘀、痰凝等阴邪上扰于心,发为胸痹心痛。两家在选方用药时均重用辛味药。辛能散能行,具有发散、行气行血的功效,重用辛味药则温通胸阳,行气活血化痰,止痹痛。但在辨别病位方面,张机偏重于中、上二焦,如心肺相关的瓜蒌薤白白酒汤证、瓜蒌薤白半夏汤证,心脾相关的茯苓杏仁甘草汤证、人参汤证等。叶桂则偏重于三焦,如上焦医案的瓜蒌薤白白酒汤证、瓜蒌桃仁方证;中焦医案的小半夏汤证、半夏干姜方证;下焦医案的苓桂味甘汤证、生地阿胶方证等。在治疗胸痹心痛重症时,二家因地域的不同遣方用药有所差别。张机生活在北方,北方人大多体质坚实,气深而厚,宜用重剂,故张机用大辛大热之重剂回阳救逆。叶桂居住在江南,南方人偏瘦弱,腠理疏松,气浮而薄,宜用轻剂,故叶桂选用轻剂辛甘化阳,甘缓救逆。两家在论治胸痹心痛的思想上有同有异、不拘一格。文章对两家理论进行综合分析,各取所长,以供临床参考。ZHANG Ji a famous medical expert in the late Eastern Han Dynasty, once had a systematic discussion on thoracic obstruction heartache in the Jingui Yaolue(《金匮要略》). YE Gui, a famous medical expert in Qing dynasty, studied ZHANG Ji's theory. On the basis of inheriting ZHANG Ji's theory and combining his own clinical experience, YE Gui had his own unique views on the treatment of thoracic obstruction heartache. Both YE Gui and ZHANG Ji believed that insufficient Yang(阳) in upper-Jiao(上焦) and excessive Yin(阴) in lower-Jiao(下焦) was the pathogenesis of chest pain. It means that Yang Qi(阳气) in the chest is weak, which cannot warm and nourish the viscera. The viscera function is abnormal, causing Qi stagnation, blood stasis, phlegm coagulation and other Yin pathogens, which disturb the heart and cause thoracic obstruction heartache. Both of them used pungent medicines when selecting prescriptions. Pungent medicine has the effects of dispersing, and promoting Qi(气) and blood circulation. It can warm the chest Yang, promote Qi and blood circulation, resolve phlegm, and stop thoracic obstruction. ZHANG Ji focused on the middle and upper energizer in identifying the location of the disease, and commonly used heart and lung related prescriptions such as the Gualou Xiebai Baijiu decoction(瓜蒌薤白白酒汤) and the Gualou Xiebai Banxia decoction(瓜蒌薤白半夏汤), etc.. YE Gui focused on the triple energizers, often used the Gualou Xiebai Baijiu decoction and the Gualou Taoren prescription(瓜蒌桃仁方) for upper energizer medical cases, the Xiao Banxia decoction(小半夏汤) and the Banxia Ganjiang prescription(半夏干姜方) for middle energizer medical cases, and the Linggui Weigan decoction(苓桂味甘汤) and the Shengdi Ejiao prescription(生地阿胶方) for lower energizer medical cases. In the treatment of severe thoracic obstruction heartache, the two experts used different prescriptions due to different living areas. In history, ZHANG Ji lived in the north of the Changjia

关 键 词：胸痹 心痛 《临证指南医案》 

分 类 号：R256.22[医药卫生—中医内科学]